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Waserman S, Shah A, Cruikshank H, Avilla E. Recognition and Management of Food Allergy and Anaphylaxis in the School and Community Setting. Immunol Allergy Clin North Am 2021; 42:91-103. [PMID: 34823753 DOI: 10.1016/j.iac.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Given the increasing prevalence of food allergy, schools and food service establishments must have procedures in place to accommodate those with the condition. Training staff on allergy management has been shown to improve knowledge and skills, although more research is needed to better understand its benefits. Furthermore, although there are challenges involved in maintaining unassigned stock epinephrine programs, they have the potential to reduce morbidity and mortality associated with anaphylaxis by improving access to potentially life-saving medication. Finally, food bans in schools may not be an effective part of food allergy management, and other measures should be considered instead.
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Affiliation(s)
- Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Anita Shah
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Heather Cruikshank
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Ernie Avilla
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada.
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Waserman S, Cruickshank H, Hildebrand KJ, Mack D, Bantock L, Bingemann T, Chu DK, Cuello-Garcia C, Ebisawa M, Fahmy D, Fleischer DM, Galloway L, Gartrell G, Greenhawt M, Hamilton N, Hourihane J, Langlois M, Loh R, Muraro A, Rosenfield L, Schoessler S, Tang MLK, Weitzner B, Wang J, Brozek JL. Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines. J Allergy Clin Immunol 2021; 147:1561-1578. [PMID: 33965093 DOI: 10.1016/j.jaci.2021.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022]
Abstract
Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools; we compiled data about the costs, feasibility, acceptability, and effects on health equity of the selected interventions; and we developed the following conditional recommendations: we suggest that child care centers and schools implement allergy training and action plans; we suggest that they use epinephrine (adrenaline) to treat suspected anaphylaxis; we suggest that they stock unassigned epinephrine autoinjectors, instead of requiring students to supply their own personal autoinjectors to be stored on site for designated at-school use; and we suggest that they do not implement site-wide food prohibitions (eg, "nut-free" schools) or allergen-restricted zones (eg, "milk-free" tables), except in the special circumstances identified in this document. The recommendations are labeled "conditional" due to the low quality of available evidence. More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances.
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Affiliation(s)
- Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Heather Cruickshank
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kyla J Hildebrand
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Mack
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Laura Bantock
- Department of Primary Medical Services, Sun Peaks Community Health Centre, Sun Peaks, British Columbia, Canada
| | - Theresa Bingemann
- Department of Allergy and Immunology, Rochester Regional Health, Rochester, NY; Division of Allergy, Immunology, and Rheumatology, University of Rochester, Rochester, NY
| | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Cuello-Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Quality in Health Care Residency Program, Tecnologico de Monterrey School of Medicine, Monterrey, Mexico
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
| | - David Fahmy
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David M Fleischer
- Department of Pediatrics-Allergy/Immunology, University of Colorado School of Medicine, Aurora, Colo; Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
| | - Lisa Galloway
- School District No. 73, Kamloops, British Columbia, Canada
| | - Greg Gartrell
- School District No. 73, Kamloops, British Columbia, Canada
| | - Matthew Greenhawt
- Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
| | - Nicola Hamilton
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Langlois
- District School Board of Niagara, St Catharines, Ontario, Canada
| | - Richard Loh
- Department of Immunology, Princess Margaret Hospital for Children, Subiaco, Australia
| | | | - Lana Rosenfield
- Section of Allergy and Clinical Immunology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mimi L K Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Brenda Weitzner
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julie Wang
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jan L Brozek
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Sicherer SH, Leung DYM. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2008. J Allergy Clin Immunol 2009; 123:319-27. [PMID: 19203656 DOI: 10.1016/j.jaci.2008.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 12/19/2008] [Indexed: 01/01/2023]
Abstract
This review highlights some of the research advances in anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease that were reported in the Journal in 2008. Key epidemiologic observations include a rise in anaphylaxis in a population-based study and lower rates of peanut allergy in Israel, where infants consume peanut early compared with the United Kingdom, where dietary introduction is generally delayed. Advances in food allergy diagnosis include IgE epitope mapping that discloses the likelihood and severity of allergy; studies correlating likelihood of clinical reactivity on the basis of food-specific IgE to sesame, peanut, milk, and tree nuts; and an observation that a low baseline angiotensin-converting enzyme level may be associated with having pharyngeal edema during a reaction. Molecular, immunologic, and genetic studies are discerning pathways that are key in development of food allergy, identifying new modalities to interrupt mast cell degranulation, and elucidating risks associated with penicillin allergy. Regarding treatment, clinical studies show a majority of children with milk and egg allergy tolerate these proteins in modest amounts when they are extensively heated in baked goods, and studies show promise for oral immunotherapy to treat milk allergy and sublingual immunotherapy for honey bee venom hypersensitivity. The importance of skin barrier dysfunction has continued to be highlighted in the pathophysiology of atopic dermatitis (AD). Research has also continued to identify immunologic defects that contribute to the propensity of patients with AD to develop viral and bacterial infection. New therapeutic approaches to AD, urticaria, and angioedema have been reported including use of probiotics, biologics, vitamin D, and skin barrier creams.
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Affiliation(s)
- Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA
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